Исторические аспекты и современное представление об аутоиммунном гепатите. Когда показана трансплантация печени? (Обзор литературы)

Аутоиммунный гепатит (АИГ) может возникнуть в любом возрасте, более распространен у женщин, чем у мужчин. Болезнь является проявлением аутоиммунной предрасположенности, вызванной у генетически восприимчивых людей, подверженных экологическим факторам. Патогенез АИГ до конца не изучен, но в нем участвует агрессивный клеточный иммунный ответ. Различные цитокины также влияют на патогенез и тяжесть АИГ. Это заболевание характеризуется повышенным уровнем трансаминаз: аспартат- и аланинаминотрансферазы. Гистология печени имеет решающее значение для диагностики и контроля эффективности лечения АИГ. Диагностика АИГ остается сложной проблемой в клинической практике. Аутоиммунный гепатит является одним из немногих заболеваний печени, при котором медикаментозное лечение улучшает выживаемость пациентов. Стандартные схемы лечения включают относительно высокие дозы преднизолона или преднизолона с добавлением азатиоприна. Положительный эффект при лечении стероидами наблюдается у 80–90% больных. Примерно 20% пациентов не отвечают на лечение стероидными препаратами, и для их лечения используют иммуносупрессивные препараты второй линии: микофенолата мофетил, будесонид, циклоспорин, такролимус, эверолимус и сиролимус. Опубликован опыт применения инфликсимаба и ритуксимаба. При естественном течении АИГ и резистентности к терапии имеется тенденция развития цирроза печени и прогрессирования заболевания до терминальной стадии. Этим пациентам, а также тем, у кого при постановке диагноза обнаружена фульминантная печеночная недостаточность, требуется трансплантация печени.

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